Senior Revenue Cycle ManagerSummary
In this role, you will be responsible for ensuring that goals and objectives of the RCM team are properly defined and clearly established.
Key Roles & Responsibilities
- Manage a staff of up to 20 Reimbursement and Coding Specialists holding them accountable to productivity and accuracy benchmarks
- Ensure that department activities are managed pursuant to the Polices & Procedures Manual
- Report and explain benchmarking metrics for all functional areas of department
- Compile, analyze, and prepare various status reports for senior management review to identify trends and make recommendations
- Maintain up-to-date expertise and knowledge of Physician Ambulatory billing and related laws and regulations
- Ensure claim denials are being reviewed and analyzed to determine if automated rules can reduce certain denials
- Provide provider coding audits on an as needed basis
- Provide coding education and training to providers on an as needed basis
- Responsible for coordination of all external coding and documentation audit activities with outside consultants and third party payers including Federal and State agencies (i.e., RAC, CERT, PCA, MAC, ZPIC etc.).
- Reviews and studies all information published by CMS and the OIG via the Federal Register, fraud alerts, OIG advisory opinions, and other publications relative to coding, billing and reimbursement compliance.
- Reviews and studies all information from third party payers relative to claims filing, coding, and the adjudication process
- Proven ability to provide feedback and training to physicians and company leadership regarding federal and state coding regulations, medical documentation, and compliance guidelines; audit results; and risk areas.
- Strong familiarity with medical terminology and the patient medical record required. Knowledge of multiple EMR systems required (Allscripts PRO, Allscripts Touchworks, Athena a plus)
- Works with Director of Revenue Cycle Management to establish baseline benchmarks for department functions and department staff member productivity
- Handles escalation of complex patient and/or Physician requests and/or complaints
- Performs Annual employee reviews of direct reports
- Represent UH | CNMG's at business meetings with billing partners/vendors, clients, and other related organizations
- Assist Director of Revenue Cycle Management with the managing and maintenance of multiple RCM system applications. Includes adding/editing Providers, Insurance Carriers, CPT Codes, Diagnoses, Practice Locations, coding rules, and system upgrades
- Work closely with Director of Revenue Cycle Management and EMR department to ensure EMR templates are designed to maximize payor reimbursement
- Assist Director in managing multiple revenue cycle groups and multiple Practice Management Billing systems to include several New England locations.
Qualifications
- Education and Experience:
- High School diploma or GED required
- Associates Degree desirable
- Certified Professional Coder (CPC) desirable
- Minimum 10 years of experience preferred in Physician Healthcare billing. Practice Management experience a plus
- Minimum 5 years of experience in a Management role required
- Personal Qualities
- Innovative
- Resourceful
- Independent
- Enthusiastic
- Computer skills
- MS Office, especially Excel
- Crystal Reports desirable
- Business Intelligence application (Precision BI a plus)
- Practice management applications (Allscripts Ntierprise and Athena a plus)
- EMR applications (Allscripts PRO, Allscripts Touchworks, Athena a plus)
- Broad understanding of Medical billing and RCM operations.
- Proficient in CPT/ICD-10 Coding and Billing.
- Skillful in problem resolution.
- Encourages teamwork, energetic, and positively motivates teams and individuals.
- Excellent analytical and problem solving skills.
- Excellent oral and written communication skills.
- Excellent organizational and time management skills.
- Ability to work both independently and within a team.
- Ability to handle multiple assignments simultaneously.
- Ability to lead others toward objectives and goals.
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